Abstract
Purpose
To compare the results for patients treated with intercalary endoprosthetic replacement (EPR) or intercalary allograft reconstruction for diaphyseal tumours of the femur in terms of: (1) reconstruction failure rates; (2) cause of failure; (3) risk of amputation of the limb; and (4) functional result.
Methods
Patients with bone sarcomas of the femoral diaphysis, treated with en bloc resection and reconstructed with an intercalary EPR or allograft, were reviewed. A total of 107 patients were included in the study (36 EPR and 71 intercalary allograft reconstruction). No differences were found between the two groups in terms of follow-up, age, gender and the use of adjuvant chemotherapy.
Results
The probability of failure for intercalary EPR was 36% at 5 years and 22% for allograft at 5 years (p = 0.26). Mechanical failures were the most prevalent in both types of reconstruction. Aseptic loosening and implant fracture are the main cause in the EPR group. For intercalary allograft reconstructions, fracture followed by nonunion was the most common complication. Ten-year risk of amputation after failure for both reconstructions was 3%. There were no differences between the groups in terms of the mean Musculoskeletal Tumor Society score (27.4, range 16–30 vs. 27.6, range 17–30).
Conclusions
We have demonstrated similar failure rates for both reconstructions. In both techniques, mechanical failure was the most common complication with a low rate of limb amputation and good functional results.
Level of evidence
Level III, therapeutic study.
Similar content being viewed by others
References
Benevenia J, Kirchner R, Patterson F, Beebe K, Wirtz DC, Rivero S, Palma M, Friedrich MJ (2016) Outcomes of a modular intercalary endoprosthesis as treatment for segmental defects of the femur, tibia, and humerus. Clin Orthop Relat Res 474(2):539–548
Jeys LM, Kulkarni A, Grimer RJ, Carter SR, Tillman RM, Abudu A (2008) Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis. J Bone Jt Surg Am 90(6):1265–1271
Mankin HJ, Doppelt SH, Sullivan TR, Tomford WW (1982) Osteoarticular and intercalary allograft transplantation in the management of malignant tumors of bone. Cancer 15(50):613–630
Abudu A, Carter SR, Grimer RJ (1996) The outcome and functional results of diaphyseal endoprostheses after tumour excision. J Bone Jt Surg Br 78:652–657
Aponte-Tinao L, Farfalli GL, Ritacco LE, Ayerza MA, Muscolo DL (2012) Intercalary femur allografts are an acceptable alternative after tumor resection. Clin Orthop Relat Res 470(3):728–734
Donati D, Capanna R, Campanacci D, Del Ben M, Ercolani C, Masetti C, Taminiau A, Exner GU, Dubousset JF, Paitout D et al (1993) The use of massive bone allografts for intercalary reconstruction and arthrodeses after tumor resection. A multicentric European study. Chir Organi Mov 78(2):81–94
Muscolo DL, Ayerza MA, Aponte-Tinao L, Ranalletta M, Abalo E (2004) Intercalary femur and tibia segmental allografts provide an acceptable alternative in reconstructing tumor resections. Clin Orthop Relat Res 426:97–102
Ortiz-Cruz EJ, Gebhardt MC, Jennings LC, Springfield DS, Mankin HJ (1997) The results of transplantation of intercalary allografts after resection of tumors: a long-term follow-up study. J Bone Jt Surg Am 79:97–106
Ceruso M, Falcone C, Innocenti M, Delcroix L, Capanna R, Manfrini M (2001) Skeletal reconstruction with a free vascularized fibula graft associated to bone allograft after resection of malignant bone tumor of limbs. Handchir Mikrochir Plast Chir 33:277–282
Chang DW, Weber KL (2005) Use of a vascularized fibula bone flap and intercalary allograft for diaphyseal reconstruction after resection of primary extremity bone sarcomas. Plast Reconstr Surg 116:1918–1925
Krieg AH, Davidson AW, Stalley PD (2007) Intercalary femoral reconstruction with extracorporeal irradiated autogenous bone graft in limb-salvage surgery. J Bone Jt Surg Br 89(3):366–371
Nakamura T, Abudu A, Grimer RJ, Carter SR, Jeys L, Tillman RM (2013) The clinical outcomes of extracorporeal irradiated and re-implanted cemented autologous bone graft of femoral diaphysis after tumour resection. Int Orthop 37(4):647–651
Cañadell J, Forriol F, Cara JA (1994) Removal of metaphyseal bone tumours with preservation of the epiphysis: physeal distraction before excision. J Bone Jt Surg Br 76:127–132
Tsuchiya H, Tomita K, Minematsu K, Mori Y, Asada N, Kitano S (1997) Limb salvage using distraction osteogenesis: a classification of the technique. J Bone Jt Surg Br 79:403–411
Bus MP, Dijkstra PD, van de Sande MA, Taminiau AH, Schreuder HW, Jutte PC, van der Geest IC, Schaap GR, Bramer JA (2014) Intercalary allograft reconstructions following resection of primary bone tumors: a nationwide multicenter study. J Bone Jt Surg Am 96(4):e26. https://doi.org/10.2106/JBJS.M.00655
Aldlyami E, Abudu A, Grimer RJ, Carter SR, Tillman RM (2005) Endoprosthetic replacement of diaphyseal bone defects. Long-term results. Int Orthop 29(1):25–29
Aponte-Tinao LA, Ayerza MA, Muscolo DL, Farfalli GL (2015) Should fractures in massive intercalary bone allografts of the lower limb be treated with ORIF or with a new allograft? Clin Orthop Relat Res 473(3):805–811
Frisoni T, Cevolani L, Giorgini A, Dozza B, Donati DM (2012) Factors affecting outcome of massive intercalary bone allografts in the treatment of tumours of the femur. J Bone Jt Surg Br 94(6):836–841
Thompson RC, Pickvance EA, Garry D (1993) Fractures in large segment allografts. J Bone Jt Surg Am 75:1663–1673
Moran SL, Shin AY, Bishop AT (2006) The use of massive bone allograft with intramedullary free fibular flap for limb salvage in a pediatric and adolescent population. Plast Reconstr Surg 118:413–419
Hsu RW, Wood M, Sim FH, Chao EY (1997) Free vascularized fibular grafting for reconstruction after tumour resection. J Bone Jt Surg Br 79:36–42
Zaretski A, Amir A, Meller I, Leshem D, Kollender Y, Barnea Y, Bickels J, Shpitzer T, Ad-El D, Gur E (2004) Free fibula long bone reconstruction in orthopedic oncology: a surgical algorithm for reconstructive options. Plast Reconstr Surg 113:1989–2000
Muscolo DL, Ayerza MA, Aponte-Tinao L, Farfalli G (2008) Allograft reconstruction after sarcoma resection in children younger than 10 years old. Clin Orthop Relat Res 466:1856–1862
Muscolo DL, Ayerza MA, Aponte-Tinao LA (2006) Massive allograft use in orthopedic oncology. Orthop Clin North Am 37:65–74
Hanna SA, Sewell MD, Aston WJ, Pollock RC, Skinner JA, Cannon SR, Briggs TW (2010) Femoral diaphyseal endoprosthetic reconstruction after segmental resection of primary bonetumours. J Bone Jt Surg Br 92(6):867–874
Henderson ER, O’Connor MI, Ruggieri P, Windhager R, Funovics PT, Gibbons CL, Guo W, Hornicek FJ, Temple HT, Letson GD (2014) Classification of failure of limb salvage after reconstructive surgery for bone tumors: a modified system including biological and expandable reconstructions. Bone Jt J 96:1436–1440
Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of the musculoskeletal system. Clin Orthop Relat Res 286:241–246
Albergo JI, Gaston CL, Aponte-Tinao LA, Ayerza MA, Muscolo DL, Farfalli GL, Jeys LM, Carter SR, Tillman RM, Abudu AT, Grimer RJ (2017) Proximal tibia reconstruction after bone tumor resection: are survivorship and outcomes of endoprosthetic replacement and osteoarticular allograft similar? Clin Orthop Relat Res 475(3):676–682
Ritacco LE, Farfalli GL, Milano FE, Ayerza MA, Muscolo DL, Aponte-Tinao L (2013) Validity of an automatic measure protocol in distal femur for allograft selection from a three-dimensional virtual bone bank system. Cell Tissue Bank 14(2):213–220
Myers GJ, Abudu AT, Carter SR, Tillman RM, Grimer RJ (2007) The long-term results of endoprosthetic replacement of the proximal tibia for bone tumors. J Bone Jt Surg Br. 89:1632–1637
R Core Team (2014) R: a language and environment for statistical computing. Vienna, Austria. http://www.Rproject.org. Accessed Aug 2016
Gupta S, Kafchinski LA, Gundle KR, Saidi K, Griffin AM, Wunder JS, Ferguson PC (2017) Intercalary allograft augmented with intramedullary cement and plate fixation is a reliable solution after resection of a diaphyseal tumour. Bone Jt J 299-B(7):973–978
Campanacci DA, Totti F, Puccini S, Beltrami G, Scoccianti G, Del Croix L, Innocenti M, Capanna R (2018) Intercalary reconstruction of femur after tumour resection: is a vascularized fibular autograft plus allograft a long-lasting solution? Bone Jt J 100-B(3):378–386
Campanacci DA, Puccini S, Caff G, Beltrami G, Piccioli A, Innocenti M, Capanna R (2014) Vascularized fibular grafts as a salvage procedure in failed intercalary reconstructions after bone tumor resection of the femur. Injury 45(2):399–404
San-Julian M, Dolz R, Garcia-Barrecheguren E, Noain E, Sierrasesumaga L, Cañadell J (2003) Limb salvage in bone sarcomas in patients younger than age 10: a 20-year experience. J Pediatr Orthop 23:753–762
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Albergo, J.I., Gaston, L.C., Farfalli, G.L. et al. Failure rates and functional results for intercalary femur reconstructions after tumour resection. Musculoskelet Surg 104, 59–65 (2020). https://doi.org/10.1007/s12306-019-00595-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12306-019-00595-1